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The WOCN Society works to educate payers and public policy makers about the value of the WOC nurse while also educating members about reimbursement policy and keeping them apprised of changes in reimbursement policy. Rules for billing are complicated, scattered throughout Federal and State law, and vary from payer to payer. The WOCN Society frequently receive questions from membership regarding reimbursement issue and attempt to answer those questions through the following reimbursement fact sheets.

In 2009 the WOCN Board developed a strategic plan for the following three years. This ambitious plan included a mandate for the National Public Policy Committee (NPPC) to develop an action plan and a section of this mandate included the following: Expand reimbursement for WOC nursing services. A task force of WOCN members from the NPPC as well as past leadership was called into action to address a work plan to meet the mandate of expanding reimbursement opportunities for WOC nursing services. A discussion of tactics as well as review of opportunities for WOC nurses to seek reimbursement was done in order to organize the work of the newly created Reimbursement Task Force. The Task Force, discussed reimbursement opportunities and road blocks. It became clear that reimbursement for some services a WOC advanced practice nurse provided was available in some settings and some locations.

The purpose of this document is to provide the APRN with information to understand the opportunities and challenges in acquiring reimbursement for professional services.

In order for the APRN role to survive in many settings, a revenue stream may need to be developed. There are increased opportunities for billing of APRN services and it is important that APRNs understand the issues involved in capturing third party reimbursement. There are many legal and financial issues that need to be appreciated by the APRN as they relate to reimbursement. Reimbursement is a complex structure that includes regulatory factors both at the state and federal level.

While this fact sheet will cover Medicare billing regulations, many insurers will follow Medicare guidelines. However, the APRN should remember that insurers may regulate reimbursement in their own way.

The purpose of this document is to understand the issues involved in Medicare Part B "incident to" billing that may be considered for use in billing wound, ostomy, and continence nursing services in the out patient setting.

"Incident to" refers to a Medicare billing mechanism, allowing services furnished in an outpatient setting to be provided by auxiliary personnel and billed under the provider's national provider identification (NPI) number. "Incident to" the provider's professional services means that the services or supplies are furnished as an integral, although incidental, part of the provider’s professional services in the course of diagnosis or treatment of an injury or illness (Medicare Benefit Policy Manual, 2011).

The Wound, Ostomy and Continence Nurses Society is accredited with distinction as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

The Wound, Ostomy and Continence Nurses Society is approved by the California Board of Registered Nursing, Provider Number CEP 15115.

PLEASE BE ADVISED: The names and contact information for all individuals listed on this site is privileged, confidential information and intended for specific purposes. No one (individual or company) may use any contact information on the WOCN Society website to contact, to distribute information to, or solicit anyone for any reason other than the intended purpose for which the name and contact information is available.